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Organization

KIDS STATION PEDIATRICS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DONALD FRANCIS MORDAVSKY MD (CEO)
(860) 643-7973
Entity
Organization

Contact information

Practice address
191 MAIN ST, MANCHESTER, CT 06042-3556
(860) 643-7973
(860) 643-0175
Mailing address
191 MAIN ST, MANCHESTER, CT 06042-3556
(860) 643-7973
(860) 643-0175

Taxonomy

Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
363LP0200X
Pediatric Nurse Practitioner
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
004132651
CT
Enumeration date
06/25/2007
Last updated
10/08/2013
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